The DRCOG is a three-hour computer-based examination of 120 single best answer questions, each worth two marks, and extended matching questions are no longer part of it. What matters more than the format is the perspective it is written from. This is a diploma for doctors practising women's health in primary care, not a specialist obstetric qualification, and once you internalise that, the questions stop being a test of obstetric knowledge and become a test of scope: what you can safely manage, what you must refer, and how urgently.
Key takeaways
- The exam is 120 single best answer questions in three hours, each worth two marks, with no negative marking.
- Almost every question is asking whether this belongs in primary care, and if not, how urgently it must leave.
- Establish pregnancy status first, because it changes the differential, the investigation and the drug.
- Sort referral into three tempos: routine, urgent, and emergency. They are not interchangeable.
- Contraception and its eligibility rules are the highest-yield content in the diploma.
The scope question
Read a DRCOG question and, before you consider the medicine, ask what is really being tested. It is almost always one of four things.
Can I manage this in primary care, and if so, how?
Does this need a referral, and to whom, and how urgently?
Is this an emergency that needs to be in hospital today, or now?
Which investigation, of those actually available to me in general practice, is the right next step?
That framing is a considerable simplification of what looks like an intimidating breadth of obstetrics and gynaecology, and it is the framing the examiners are using.
Pregnancy status is the master variable
Before anything else, establish whether this woman is or might be pregnant, because it changes the answer to almost every question that follows.
It changes the differential: the same abdominal pain, the same bleeding, the same collapse mean entirely different things depending on the answer.
It changes the investigation: what you can image, what you can request, and what you must do first.
It changes the drug: what is safe, what is contraindicated, and what requires specialist input.
And it changes the urgency: ectopic pregnancy is the reason a woman of reproductive age with abdominal pain is not a routine problem until proven otherwise, and the exam constructs questions around candidates who did not think of it.
If a vignette does not state pregnancy status, that omission may itself be the question.
The three tempos of referral
Referral is not one thing, and the diploma tests whether you can distinguish its tempos.
Emergency. This woman needs to be in hospital now, and the answer involves an ambulance or an immediate admission rather than a letter. Suspected ectopic, significant haemorrhage, sepsis, severe pre-eclampsia, ovarian torsion.
Urgent. She needs to be seen soon, within a defined window, and the answer is an urgent referral pathway. Suspected gynaecological cancer meeting the criteria, and the criteria are examinable.
Routine. She can wait, and the referral is a normal one, and often the correct answer is to do something in primary care first, because a referral without an initial investigation or a trial of management is frequently the wrong answer.
Candidates lose marks in both directions: by referring what they should have managed, and by managing what they should have referred, and the exam is testing precisely that judgement.
Contraception is the highest-yield content
If your revision time is limited, weight it here.
Contraception is a substantial part of the syllabus, it is entirely learnable, and it rests on a four-category eligibility framework in which each combination of method and patient characteristic is assigned a category from no restriction through to unacceptable risk.
The exam constructs eligibility questions by giving you a straightforward patient and one detail that moves her between categories: the migraine and whether it has aura, the blood pressure, the age together with the smoking, the recent childbirth, the venous thromboembolism history. Finding that detail is the question.
Alongside eligibility sit the timing rules, which are the other half of the domain: when a method can be started without additional cover, what counts as a missed dose, and what to do when one is missed. These are finite, non-derivable and they interfere with each other badly, which means they must be retrieved and spaced rather than read. We set out the method in contraceptive eligibility and timing rules.
The domains that carry the rest
Beyond contraception, the syllabus divides cleanly, and the divisions tell you where to work.
Early pregnancy problems. Bleeding, pain, miscarriage, ectopic, hyperemesis. This is where the emergencies live and where the exam is least forgiving.
Antenatal care. The schedule, the screening, and the conditions that arise in pregnancy and how primary care recognises and escalates them.
Intrapartum and postnatal care. Including the postnatal problems that actually present to a GP rather than to a labour ward.
Gynaecology. Abnormal bleeding, pelvic pain, prolapse, incontinence, and the referral thresholds for suspected malignancy.
Menopause. Increasingly examined and increasingly relevant to primary care practice.
Sexual and reproductive health. Infections, screening, and the management that belongs in general practice.
Two marks a question changes nothing, and one thing
A practical note on the format. Each question is worth two marks rather than one, and the total is 240. This does not change your strategy, because every question is worth the same as every other, and there is no negative marking.
What it does mean is that a question skipped is worth two marks rather than one, which is worth remembering when you are short of time. Never leave a question unanswered. Eliminate what you can and guess between the rest, because a blank guarantees zero and a guess does not.
Where iatroX fits
iatroX's DRCOG bank is mapped to the diploma syllabus with questions written from the primary care perspective the exam actually uses, so you practise the scope judgement rather than specialist obstetrics. Explanations are grounded in the relevant national guidance, the adaptive engine shows you which of the syllabus modules is genuinely weakest rather than letting a comfortable overall percentage hide it, and spaced repetition returns the eligibility categories and timing rules that decay fastest. Missed questions can be opened in the Socratic Tutor, which asks you to reason before it explains. Try it with free sample questions at iatroX.
Frequently asked questions
What is the format of the DRCOG? A single three-hour computer-based examination of 120 single best answer questions, each worth two marks for a total of 240. Extended matching questions are no longer used, there is no negative marking, and the pass mark is set by a modified Angoff method so it varies between sittings.
What is the DRCOG really testing? Scope. Almost every question asks whether a presentation can be managed in primary care, whether it needs referral and how urgently, or which of the investigations actually available to a GP is the right next step. It is not a miniature specialist examination.
What should I revise first? Contraception, including the four-category eligibility framework and the timing rules. It is a substantial part of the syllabus, it is entirely learnable, and the rules are non-derivable, which means they need spaced retrieval rather than reading.
Why does pregnancy status matter so much? Because it changes the differential, the investigation, the drug and the urgency all at once. Ectopic pregnancy is why a woman of reproductive age with abdominal pain is never a routine problem until it has been excluded, and questions are built around candidates who did not consider it.